ATLANTA, Ga. — If a pain clinic is advertising physician openings on CraigList, odds are that clinic is engaged in illegal activity.

“They’re no better than street-corner drug slingers,” said Joseph T. Rannazzisi, a deputy assistant administrator for the U.S. Drug Enforcement Administration’s Office of Diversion Control.

Rannazzisi told an audience of law enforcement professionals at the National Rx Drug Abuse Summit that they should look at physicians and prescribers who use fraud and deception to flood the streets with addictive opiate medications as drug traffickers.

For example, Rannazzisi explained how customers in one state can order opiate prescription drugs online, and how that order can be approved by physicians and filled by pharmacists in different states.

“All this is a conspiracy and it’s a totally illegal act,” Rannazzisi said. “It’s drug trafficking.”

Rannazzisi also showed his audience an undercover DEA surveillance video of dozens of people walking into a Florida pain clinic — a notorious “pill mill” that was later shut down — at the exact same time the clinic opened its doors one morning.

“Think of this as a modern-day crack house,” Rannazzisi said.

Prescription medicine abuse has been around “for a long time,” but it was not until OxyContin hit the market in the mid-1990s that law enforcement and emergency responders across the country began seeing a dramatic spike in overdoses.

“As the drugs got more potent, we started seeing more deaths,” Rannazzisi said.

As more people got addicted to opiate painkillers, many of them eventually transferred to heroin — which is cheaper and molecularly almost identical to Percocets and Oxycontin — when they no longer had access to prescription drugs. As the market for heroin grew, so did the criminal organizations that distribute it.

“We’ve seen heroin organizations moving into areas that they were never in before, “ Rannazzisi said. “And they bring increased crime, burglaries, robberies. These organizations are now in counties in Middle America, not just the big cities like New York and L.A.”

In recent years, the DEA has partnered with local, state and other federal law enforcement agencies in targeting “pill mills,” unscrupulous physicians, pharmacists and other individuals responsible for distributing opiate medications to the streets.

“We’ve put a lot of rogue actors out of business,” said Regina Labelle, chief of staff of the White House Office of National Drug Control Policy.

Rannazzisi advised law enforcement officials to look for “red flags” in opiate prescribing trends, and said treatment providers, prescription drug monitoring programs, pharmacists and medical practitioners are often great sources of information. He suggested using undercover investigations and surveillance to build cases. He also said to grant physicians the benefit of the doubt until they prove to be rogue.

Page 2 of 2 - “There are a lot of good physicians are out there,” Rannazzisi said. “But the damage done by a small percentage of bad apples is pretty large.”

The enforcement efforts are also not just restricted to street-level efforts. At least nine states have passed laws to regulate pain management clinics, with stricter physician certification requirements and mandates that the clinics participate in prescription drug monitoring programs.

In Kentucky, the state has gone after pharmaceutical companies for alleged unlawful marketing practices, according to Kentucky Attorney General Jack Conway.

In January, the Kentucky Attorney General’s Office reached a $40 million settlement with pharmaceutical companies Merck Sharp & Dohme Corporation, which produces Vioxx, and GlaxoSmithKline, which produces Avandia, a diabetes drug. The Kentucky attorney general’s office said the companies failed to disclose important health risk information about the drugs to customers.

Conway said his office used the settlement money to establish drug-free homes for people transferring out of residential treatment programs and the construction of a new Kentucky Recovery Center, among other initiatives. Conway said his office has a pending lawsuit against Purdue Pharma for how it marketed OxyContin.

Conway said his office’s actions show that state’s attorneys general can fight opiate prescription drug abuse if they have the political will.

“I think we’re making strides,” Conway said. “Albeit, it’s one step at a time, but we are making strides.”